Saturday, September 29, 2007

- HDL: Recently, maybe last week, it was noted that Niacin is helpful in controlling the effects of cholesterol. I may not have realized this at the time, but Niacin is known for increasing the HDL which is the good kind of cholesterol and the one often associated with exercise or being from a certain region in Italy. There had been some hope in the medical and pharmaceutical industry that the need for high HDL could be reduced by having the lowest possible LDL. Research out this week did not support that theory. Instead, it is heart protective for a person to have both low bad cholesterol and high good cholesterol. The story on this research noted that at this time the best way to do that is by maintaining a low weight and by exercising daily. Things you might already be mindful of.- Nicotine: A very important and health related bit of education for you. Nicotine in cigarettes is what leads to addiction. Nicotine in cigarettes is associated with an increase in heart rate. Nicotine in nicotine replacement therapy does not usually increase heart rate as it is a lower dose and less quickly absorbed. Nicotine in NRT is rarely addictive, though nasal spray NRT is more so then say, the patch. What kills smokers and nonsmokers in cigarettes is NOT nicotine, it is TAR and Carbon Monoxide. Tar is the substance that changes DNA’s instructions and leads to cancerous mutations and CO is the component that leads to Heart Disease and other lung conditions. This is extremely important. Nicotine does not kill you, the combustion, the smoke, will. That being said, please considers quitting smoking today and using NRT to assist you with the cravings and withdrawal. Cigarette smoke does not physiologically decrease stress, the reason persons who quit return to smoking may be because they are experiencing unpleasant withdrawal symptoms. Those symptoms can be addressed with NRT and pharmacological assistance; the symptoms of withdrawal will abate and all together disappear in time.- Alcohol and Breast Cancer: HMMM, this is related to a recent research study that I have not had the chance to read. So this really is more based on the headline than on my review of the study. That being said, a study states that alcohol use has already been related to breast cancer when this use is more than one drink per day. A study that looked at breast cancer patients who drank reviewed WHAT they had been drinking. The results are that any alcohol, a beer, a mixed drink or a glass of wine, consumed over one drink per day is related to breast cancer incidence. A very important note in the article that I read however is that WEIGHT, AGE and GENETICS are far more predictive factors. So the message to you, as a woman is this, WHAT of those do you have power over. The answer is, weight and alcohol intake.- Smoking: This information was shared with me from an instructor with the University of Medicine and Dentistry NJ on this date actually. I trust that this fact was culled from the research and so I share it with you. For every year that one smokes past the age of 30 (not that one should smoke before the age of 30), three months of life is lost. This means that quality life years are lost, not that you die a year or two earlier than you might have. It is very important that smokers understand, that all of us understand, our life choices can lead to slow, painful and debilitating deaths. It is not something to blow off, saying so what, I die two years earlier, instead it is oh no, you die ten slow years when you could have been living the good life.- Exercise and Intake: Many people are concerned about increasing the amount of time they spend exercising which is awesome. Sedentary lifestyles contribute to disease and early death for more than the weight reason. Remember exercise increases HDL. In this past week, I heard several people bemoan their aversion to exercise; something they know is good for them. However, I watched the same people eat significant portions of food and food that even in small portions is calorically dense. This seemed an astounding disconnect to me. It really has to be both weight control AND exercise.

Okay friends, I have been in training on tobacco cessation treatment for this full work week and am now in the airport terminal waiting my twice delayed flight home to NC, where I will be spending a few short days before moving to Florida. Hope the news still makes sense in spite of my crazy schedule!Yours in Wellness

Friday, September 21, 2007

FMS: Here is another example of taking a condition, making it common and treatable and marketing a drug to address it. I don’t like it and it goes back to the direct to consumer marketing that raises healthcare prices for all of us. It relegates a physician to no more than the guy/gal who fills your order. Doctor, I have FMS (fibromyalgia syndrome) and need that pill I heard about on TV. Oh, and I’ll take that to go, thank you very much.Drugs: They’re on my mind this week. Niacin is often recommended as a more natural and reasonably priced option for preventing heart disease through reduction of blood cholesterol. So, I believe it is an alternative to statin drugs. Anyway, sometimes niacin causes flushing of the skin and a burning sensation, or it always does in some people. A drug company is now working on a niacin compound that has shown a decrease in these symptoms for a certain percent of their study group. So the niacin option will become an expensive prescription treatment in the future. This begs the question; why not just take the generic statin drug?

Anemia Drugs: These drugs, or class of drugs, are in the news a lot these days. There is more than one kind though they may all be injectable. The risks associated with these drugs include cardiac problems and a link to cancer. Ironically, one of the approved groups for the pills are those receiving chemotherapy. The drugs are also used in kidney disease treatment. While some insurers are pulling back on coverage and makers of the drugs are trying to improve them, this statement struck me as a little off putting, but reality can be so. The statement, read in the Wall St Journal on 9/4/07 is attributed to a spokesman from pharmaceutical company Roche. She said, “Anemia is still a large market.” Well, I thought it was a blood disorder that led one to feeling weak and tired.

Labels: Remember that label reading is important. I’ve said this for years and want to reiterate a past admonition. Keep Looking at them. Nutrient info can change. For example, this week I noticed my same old yogurt, flavor, size, brand, etc now has ten more calories. Also, my same old calcium brand now has two tabs as a serving size and claims more vitamin D. My separate vitamin D has fancy new bone health proclamations on the label. On a positive note, it is good to see that Dr. Willett’s message as supported by research is being mainstreamed. That is the case for vitamin d supplementation and bone protection.

Kids: Hot news. That Go Slow Whoa program out of Sarasota Food and Nutrition Services (School Board) continues to ROCK> No meals offer whole milk and only skim milk is on the green or go list. I am really happy to report this next tidbit but sort of miffed as well. The FDA and some ADA representatives are encouraging children to read nutrition labels. Tweens, those in middle school are the target of this incentive. Listen, I said exactly this over a year ago when I worked out my OPP, or Obesity Prevention Project aimed at middle school children. UGH! I included social influence and self determination theory which would empower the children to know why they wanted to read the labels and what to look for when they did. That would encourage them to make the choices that would keep them at a healthy weight. The more they did this the more likely it would be, will be, that food companies and even establishments, will provide more nutrition content on labels and menus! Who do I have to work for to be heard for goodness sakes! Lastly in this section, toddlers are increasingly overweight and iron deficient. How in the hell does THAT happen? (rhetorical)

In Treatment/Colon Cancer: Many cancer patients are advised to eat health promoting, nutritious and low fat, low calorie foods to maintain a healthy weight in treatment and beyond. This is true for colon cancer patients as well. Because there is a growing body of research to support a link between diet and colon cancer and studies now confer an IMPACT on treatment and survivability with the same foods, the following is noted. Refrain from or limit red meats and processed meats and foods high in fat as well as high sugar foods like desserts. Protective factors on the other hand include not being overweight and staying active. Sometimes people will say, YES But, I am too tired to exercise. I say to them……. You are NOT too tired to exercise; you are tired because you don’t exercise.

Did you Know: Tobacco farming is having a resurgence and not for biofuel either but to meet the needs of smokers in China, for example. There are no more tobacco quotas in the US after a buyout a few years ago and this may turn lucrative for the farmers past and new. I do wonder what effect if any, this will have on the funds that some states have set aside from the Master Settlement Agreement that funds programs to help displaced tobacco farmers become something different. The story that I read about this increased demand for tobacco also noted that the cigarette makers are courting the farmers in order to meet current and future demand. That future demand is new smokers and people don’t generally start smoking in their thirties and forties, no, those new smokers are YOUR children. Talk to them, check out, or have them check out Students Working Against Tobacco. http://www.gen-swat.com/gen-swat1/enemy.htmlAnother bit of news this week about tattoos noted that about 25% of us have them, which is about the same percent of US smokers. Well, I am one of the first 25% --- J

I will be in NJ next week at the University of Medicine and Dentistry and if all goes well, I will be a Certified Tobacco Dependence Treatment Specialist when I come home…… oh man, do I need more ammunition or what.Wishing you wellness

Friday, September 14, 2007

Weekly News

Hydration: Caffeine vs sugar. In listening to a Health Matters show from NPR recently, I learned that sugar in beverages can actually decrease the amount of hydration or water that is absorbed much more so than caffeine does. This news supported my own choice of using eletewater electrolyte replacement over Gatorade. Sugar is not helpful for hydration. This news story did not address energy needs. Caffeine does decrease absorption but not as much as we expect. For example, the story noted a 100 ml difference, say from 400 intake without caffeine and 300 with. That is not such a big loss. Sugar has to be metabolized and that depletes your water stores further.

Drink Wars: Ironically, Pepsi Co is preparing for battle with Coca Cola which has bought the company that sells Vitamin Water. I used Vitamin Water before I found Elete because some of them have fewer calories than Gatorade. Pepsi is about to roll out G2 with 25 calories per eight ounces. Interestingly, they mean to target athletes when they are not working out. Again, it is the non carbonated drinks that have the biggest potential for growth in the beverage industry. Before you buy any of them, consider what you really need in terms of nutrients, hydration and calories and buy accordingly.

Doctor... Is _____ right for me?: Here is a thought. Let's use the drug industry's very successful marketing strategy to address smoking. For kids, the anti tobacco groups use truth campaigns and empower youth to fight back against the lies and the glamorization of tobacco. For current, adult and long time smokers, how about a commercial that goes like this..."Do you find yourself smoking when no one else is? Are you forced to stand outside buildings as if you have the plague? Do you wake coughing, have tired old skin and stained fingers, but smoke anyway? You may have an addiction. We can help. Ask your doctor if quitting smoking is right for you. Side effects may include fresh smelling clothes, better taste and a longer life."

Smoking and Weight: Let me say, cigarettes no more make you skinny then pills make you fat. Many people who smoker, 20 to 24 % of the US adult population, fear weight gain when they consider smoking cessation. They fear this weight gain more than they fear cancer. Some people do gain weight and contrary to what some will tell you, weight gain IS a health risk. Smoking and overweight are both detrimental. Two things to know then, 1) while preparing to quit, read up on Volumetrics (see link on right) so you can have low calorie high volume foods available and 2) a recent study noted on Medscape Public Health did NOT show a significant increase in obesity with smoking cessation. It will always be a matter of EIEO.......

From my Brother In Law's Desk: My BIL left the Sarasota Herald open to a news story on food labeling and the FDA. (yes I am in Florida again) The story lamented and celebrated the food industry's current efforts to get nutrition info that you need on the package. One of the problems is that different benefits are being promoted and consistency does not exist. The FDA wants to change that. Some of the information is on this blog site already, regarding ingredient lists and label words. One item up for consideration is changing the way the package notes serving sizes so that the information offered is for the amount you are really eating. I always know this, even when it takes a little math. Here is my big question though. As the FDA is pondering this next big label change, possibly a regulation, are they going to take this one very important step and ASK US what we want?

Okay then, been a busy week of job hunting and apartment searching or job searching and apartment hunting........ anyways, I think I have both accomplished and fly back to NC Sunday..... until next time, I am always

Friday, September 7, 2007

There is a slew of news this week so maybe I'll just hit the highlights.

Cosmetic Vaginal Surgery: Huh? A procedure that is said to tone the vaginal area after it's been stretched from childbirth and time (use?) is getting a big thumbs down from the American College of Obstetricians and Gynecologists. It’s dangerous; could lead to nerve damage, infections, loss of sensation and has no evidence based data to support a benefit.

Go Slow Whoa: You may recall that I really like this traffic light labeling system which encourages people to eat more foods identified as green. There is a lot of this in Sarasota Co Florida and it really helps people make healthful eating choices. (I prefer actual nutrition content labels for my meal choices which can be used in conjunction with this method). A country is introducing this labeling system for foods. New Zealand has quite the problem with half of its population at overweight or obese levels. A government panel, called the Obesity Action Committee, advised mandatory labeling be enacted if the food industry doesn’t do it voluntarily. They mentioned energy dense foods as well. { long term reader note: Volumetrics will be the new Atkins}

Plastic Progress: Because the H2O industry, or the beverage industry which sells bottled water has taken such a hit lately (bottled tap water and ruining the environment), the top sellers are changing the way they make the bottle. Pepsi, Nestle, and Coca Cola are making lighter bottles, bottles with recycled and more recyclable plastic and are encouraging the consumer to recycle. Some states have deposit laws which encourage people to return their bottles for reuse while also reducing litter. This is in most part for glass and aluminum and is now being considered for plastic. Stay tuned for more environmentally friendly changes because on a positive note, soda sales are down and these companies want you to buy water. (you really CAN skip the protein infused water however, it's highly unlikely that most of us are lacking protein).

Soda Ad: Never missing an opportunity to blast an ad, here is another. I do drink diet soda, I know it has chemicals or some such nonnutritive ingredients that I could do without, but it's about my only such recklessness. I drink diet drinks without any misconceptions and so manufacturers only perturb me by adding vitamins and minerals to my diet coke. I am not an idiot. Those extras don't make my diet coke suddenly good for me. What is next, fiber? Geez.

Donuts!: Remember that I shared with you the concept of reciprocal determinism. It means that we shape our environment and it shapes us. We respond to each other. Well the fact that TFAs are seen as bad and people can remember that, if nothing else, has not escaped the food industry. Packages are now sporting trans fat free labels and we are buying. Shame on us for not noticing the 30 grams of sugar in the same product! Oh I digress. Also with NY City law, frying oils changed and no one much complained. So it is now safe (profit wise) and even noble to go transfree. Thus we have influenced Donkin Donuts. Donkin Donuts brands will be virtually trans free. I do laud them for being honest that their foods with less than 1/2 g per serving of TFA are not literally transfree but legally it is. Labels can say TFF when it is less than .5. So be very mindful of the serving size in comparison to the amount you are actually eating and look for TFA code words, like partially hydrogenated oils. Same rule applies with calories except the cut off to call it zero cals is 5.

Diabetes x 2: Yes, times two. One, my friend the PharmD gave me great info on diabetes and meds to treat it. I believe it all pertains to type 2 in which case your body is resistant to insulin. The first thing I noticed about the various classes of medicines, which act differently, is that they all have side effects. Some drugs increase sensitivity to insulin so that it does its job, some encourage production of insulin and some slow down the digestion or breakdown of starches so that blood sugar levels are more stabilized. Most are oral medications. Some type two diabetics eventually have no or nearly no insulin production and require pills plus insulin coverage. Second part: Last week I responded to the news about weight loss after bariatric surgery and thus decreases in chronic disease like diabetes. I wasn't the only one that saw the key factor as a healthy weight. In other words, obesity can for all intents and purposes, cause diabetes and weight loss can cure it. Dr. Richard Amerling of Beth Israel Medical Center wrote to the Wall St. Journal and included in his letter is this great statement. "A less obsessive preoccupation with normalizing blood sugar coupled with a greater emphasis on carbohydrate restricted diets and exercise will lead to more cures for type 2 diabetes, without surgery." I will add that he means simple carbs. Anyone who reads this newsletter on a regular basis would know that this man gets a top spot with Drs. Willett and Rolls for that comment.

Prevention: I will just combine the last few news stories to save time. Obesity rates have risen across the country, exercise improves survival after angioplasty (cleaning the arteries) and Medicare is making a push for preventative programs. All of this led to some intuitive pondering. Fear vs complacency? Relevancy? Urgency? Misconceptions? Instant gratification? Denial? What is going on here____ Without a doubt, research has given us a mound of evidence that our bodies cannot handle the influx of processed, high fat, high sugar foods and that there is a certain threshold at which excess weight becomes a serious, significant threat to ones health. The consequence is hypertension, diabetes, heart disease, chronic pain, depression and disability at the least, and there is strong evidence that it affects cancer incidence. We must stop this epidemic that is now endemic through prevention. Our children are not going to be able to ride any rides at theme parks for goodness sake (no one with HTN is supposed to ride!). To help the kids we have got to role model. The denial is entrenched and dangerous. This is one of my most passionate and blunt assessments but here it is:This fervent refusal to accept that overweight and obesity is caused by any thing but too much of the wrong food and too much food in general has taken on a near schizophrenic level of delusion.A person’s weight is a direct consequence of energy in and energy out. One might have a genetic predisposition that requires special attention to that concept, but the concept always holds. Same for pills. Pills do NOT make a person fat. They might change metabolism and or increase appetite, but they do NOT cause one to eat. Nor do pills cause sedentary behavior. Those things can be controlled.It's time to accept the science and start doing something different in our lives.

People want to live here and now and readily rely on HTN, DM, and cholesterol lowering meds. I am grateful that they exist and they do save and extend lives, but people take them as if it were a natural thing to do. Twenty years from now will people take chemo drugs with the same alacrity? Think about it. Heart disease is as deadly as cancer. Yes yes, you want your sweets, you DESERVE them. Sweets are considered a RED food item; the Go Slow Whoa or WeCAN program from the NHBLI tells us this:

WHOA foods are the highest in fat and added sugar. They are "calorie-dense" (high in calories), and many are low in nutrients as well. Have WHOA foods only once in a while or on special occasions. And, when you do have them, have small portions.If you do not follow the above recommendations then you may get a bad result.

Sunday, September 2, 2007

Energy Boost: It is counterintuitive, I know, yet fatigue can often be contributed to lack of activity. You may sit at your desk all day and feel exhausted but you haven't exerted yourself physically nor have you done anything to improve your cardiovascular fitness. Exercise, time after time, has been shown to increase energy, focus and concentration. Exercise is far more invigorating than any caffeine drink and safer too. Energy drinks do not improve your health and new ones that include alcohol are the focus of a wide ranging Attorneys General request for safety and marketing investigation. [I am not against caffeine in general, just in excess and in alcohol]

Pain: In recent weeks reports surfaced regarding the staggering increase in the use of pain medications, including narcotics and mostly Oxycodone/Oxycotin. Two reasons for the increase could be, people request these drugs because they heard about them on TV or doctors suggest them because they heard about them at a Pharm dinner. We have an increase in chronic pain cases in large part due to an aging population of people whose lifestyle choices may have increased their risk for degenerative disk and joint disease. These factors include inactivity and overweight. The past is done. Lose weight and become active now, in your present, for your future. Try ice or heat and movement to address your current pain as a first response. Mediation should be second line and in lowest effective dose for the shortest amount of time. [all according to your doctor's rec's of course]

Look Younger, Feel Younger, Live Longer: Stop smoking and tanning today, results in six months. Boost these results by also adopting a Mediterranean life style. Eat lean meats and fish, monounsaturated fats (oils), fruits, vegetables, and whole grains. Walk a lot. Be mindful of calories in and out.

Disability: Oh my, best quote of the year comes from former governor and current presidential candidate Mike Huckabee. This man has lost 110 pounds and consistently advocates for health promotion at work, home, and community. Mr. Huckabee works with others to especially address the fattest section of the USA, the South. I often note that wellness programs can decrease disability, here is his quote regarding who will be available to fight global acts of violence. "Who is going to fight it in the future if we are a generation so sick we don't have the capacity to show up for work." Amen

Obesity Surgery: People often ask my opinion on bariatric or gastric bypass surgery of which there are a few types. I think……… well, I think that the Gastric is Drastic. Ok. And yet, I cannot deny that some long term research studies do show that persons who receive the very invasive and expensive procedure do have a better outcome percentage wise than similar individuals that do not. First though, the risk of death with the procedure is higher than most would like and it’s a vague number, anywhere from 1 in 100 to 1 in 500 cases. Also, there are surgery complications and in many cases, depending on the type of bypass surgery, a life long need to take supplements and to eat like you have an egg sized stomach, because you do. I would so much prefer that people take steps now to prevent themselves from ever having a BMI of 30+, but I'd also rather people be well. So if this is your choice you go for it and you be well. [research note. The better outcomes were attributed to less death and heart attack related to weight loss. In other words, the control group didn't lose the same about of weight (they may or may not have been on a weight loss program)]

Risperdal: This drug, an antipsychotic medication, just received FDA approval to treat schizophrenia and bipolar disorder in children has the following side effects; weight gain, new onset diabetes 2, increased bad cholesterol and thus decreased life span. The decision is one of quality over quantity. To note however. A physician interviewed by the Wall St. Journal advised that docs be mindful of the weight gain and counsel their clients. I can tell you, it isn't happening in adults and it isn't going to happen in kids unless someone forces that kind of accountability. Very few people have the comfort level needed to say, "hey… we have to get your weight down." NOT telling your patient that they are at risk for an obesity related illness is far from best practice.

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